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[健康焦虑:另一场需应对的流行病]

[Health anxiety: Another epidemic to prepare for].

作者信息

Cathébras P, Kohout É, Savall A, Goutte J

机构信息

Service de médecine interne, hôpital Nord, CHU de Saint-Etienne, 42055 Saint-Étienne cedex 2, France.

Département de médecine générale, faculté de médecine Jacques-Lisfranc, campus Santé Innovations, 10, rue de la Marandière, 42270 Saint-Priest-en-Jarez, France.

出版信息

Rev Med Interne. 2024 Oct;45(10):641-648. doi: 10.1016/j.revmed.2024.03.002. Epub 2024 Mar 26.

Abstract

Health anxiety (HA) is a frequent problem (up to 20% of consultants in the context of secondary care) responsible for decreased well-being, disability, somatic and psychiatric complications, which contributes to high healthcare expenditures at the population level. It is likely, if not definitely established, that the prevalence of ACS is increasing, and this can partly be explained by the growing medicalization of society in general, the appetite of Media for health issues, and the uncontrolled use of the Internet (which can lead certain vulnerable subjects to cyberchondria). The pandemic of COVID-19 could have contributed to it, at least by the significant increase in the overall level of psychological distress in the population it has caused, although this has not formally been demonstrated to date. The diagnosis of ACS is easy, as soon as its assessment is considered as a mandatory part of any medical consultation. Certain intuitive attitudes of doctors, such as reassurance, prove to be iatrogenic for the patient with HA. The management of HA can be facilitated by an acculturation of physicians to cognitive conceptions of anxiety in general and HA in particular. HA is effectively treatable by certain psychotherapy and in the first place cognitive and behavioral therapies (CBT), but the availability of trained therapists and accessible at a lower cost is sorely lacking, particularly in France.

摘要

健康焦虑(HA)是一个常见问题(在二级医疗保健环境中,高达20%的会诊患者存在该问题),会导致幸福感下降、残疾、躯体和精神并发症,在人群层面造成高昂的医疗费用。即便尚未明确证实,但很有可能的是,健康焦虑症的患病率正在上升,部分原因可能是整个社会的医学化程度不断提高、媒体对健康问题的热衷,以及互联网的无节制使用(这可能导致某些易受影响的人患上网络疑病症)。新冠疫情可能也起到了推波助澜的作用,至少它导致了人群心理困扰总体水平大幅上升,尽管迄今为止尚未得到正式证实。一旦将健康焦虑症的评估视为任何医疗咨询的必要组成部分,其诊断就很容易。医生的某些直观态度,比如安慰,对患有健康焦虑症的患者来说其实是医源性的。通过让医生了解焦虑症尤其是健康焦虑症的认知概念,有助于对健康焦虑症进行管理。健康焦虑症可以通过某些心理治疗,首先是认知行为疗法(CBT)得到有效治疗,但目前严重缺乏经过培训且费用较低的治疗师,在法国尤其如此。

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